Integrate staff presentation ‘Victor Babes’ Clinical Hospital

➢ Infectious-contagious disease ➢ Koch bacillus ➢ Wide spread in the population (endemic) ➢ Untreated – important fatality

It affects the population in the most productive years of life Transmission path – mostly aerial (>95%) The main source – patients with positive TB lung microscopy ( sick people with lung cavities eliminating bacilli = bacillary sources) Infectious environment – closed spaces “Street contagion” – unknown source ( public transportation, performance halls, shops, etc.)

About 5% of newly infected people develop the disease in the following months. Global incidence of tuberculosis in Romania during 1972-2018

160 138.8 142.9 134.1 136.3133.4 140 125.3 116.1 120 110 109.7110.4 102.6 104.8 95.3 100 87.783.6 77.6 80 70 74.671.7 61 64.862.8 55.8 59.7 60

40

20

0

1972 1975 1980 1985 1990 1995 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013 2015 2016 2017 2018 2007 2014

TB incidence Total TB cases in Dolj county

No. TB cases MDR-TB XDR-TB

812 776

657 644 595

44 43 37 44 37 3 5 7 7 5

2014 2015 2016 2017 2018 ❖ Retrospective study

❖ Data from the TB register of the Craiova TB Ambulatory

❖ In period 1.01.2011 – 31.12.2018: • Total number of TB cases: 4112 • Number of cases of respiratory TB: 3362 • Number of extrarespiratory TB cases: 750 Number of TB cases 2011-2018 800 708 700 623 600 558 530 498 512 498 500 438 433 426 409 399 400 382 377 348 325 300

200 150 125 102 92 99 85 100 57 49 0 2011 2012 2013 2014 2015 2016 2017 2018

TOTAL RESPIRATORY EXTRARESPIRATORY INTEGRATE

Joint Action on integrating prevention, testing and linkage to care strategies across HIV, viral hepatitis, TB and STIs in Europe Coordinator: RegionH /CHIP Romania: - “Marius Nasta” Pneumophtisiology Institute (IPMN) - “Victor Babes” Clinical Hospital of Infectious Diseases and Pneumophtisiology Craiova (CHIDPV) Joint Action

• Joint Action (HP-JA-2016), 3rd Health Programme and 2016 Work Programme • 29 nominated partners from 15 EU countries (+ Serbia) • RegionH/CHIP (DK) is coordinator • Participation from Public Health institutions (17), Hospitals (Infectious disease and research departments) (4), NGOs (7) and Universities (1) • Launch in Brussels 19-20 Sep, 2017 • 36 Months (2017-2020) • Overall budget 2,4 mill Euro (80% EU)

European project note PILOTS

European project note INTEGRATE - objectives

European project note WP 5.2

• Pilot (CHIDPVB/Romania) – increasing HIV testing among patients diagnosed with tuberculosis • Initially - audit – the degree of HIV testing among patients with tuberculosis • Survey – completed online by doctors initially and at the end of the project (after 12 months) • Study population – all patients diagnosed with tuberculosis aged between 18 and 65 years in the records of “Victor Babes” Clinical Hospital of Infectious Diseases and Pneumophtisiology Craiova The situation of patients with HIV/AIDS infection in the Craiova Regional Center

• HIV/AIDS patients registered on 31.12.2018 – 590 • HIV/AIDS patients undergoing treatment on 31.12.2018 – 566 • Naive patients introduced in treatment in 2018 – 34 • Patients who died in 2018 – 9 • Drug users – 3 • MSM - 2 • Patients with HIV/AIDS diagnosed with TB in 2018 – 6 • Newly diagnosed patients with HIV/AIDS in 2018 with TB coinfection – 7 • HIV/AIDS patients undergoing chemoprophylaxis for TB in 2018 – 1 • Patients with HIV/AIDS and chronic hepatitis B virus being treated – 76 • Patients with HIV/AIDS and chronic hepatitis C virus being treated - 0 • National Program for the Prevention, Surveillance and Control of Tuberculosis – it is mandatory for every TB patient to be tested for HIV

• For HIV testing, psychological counseling takes about 20 minutes

• Following psychological counseling, each patient signs informed consent for HIV testing • About 60% of the patients with HIV/AIDS have an episode of tuberculosis in their lifetime

• Once diagnosed with HIV infection, a patient has a lung X-ray and is tested for hepatitis B and C

• When the patient with HIV/AIDS has respiratory symptoms, a lung X-ray is take Informed consent Patient information leaflet – PIL

• Decreases the duration of psychological counseling • The number of HIV tests is increasing among patients diagnosed with tuberculosis • Eliminates some barriers related to low HIV testing (little time spent on psychological counseling, some misunderstandings about HIV testing, etc.) • Answer some questions about the discovery of HIV/AIDS in tuberculosis patients

HAVING AN HIV TEST AT THE TUBERCULOSIS CLINIC

Spitalul Clinic de Boli Infecțioase și Pneumoftiziologie “Victor Babeş” Craiova Clinica Pneumoftiziologie I

Tuberculosis

As a patient at the Pneumophtisiology clinic you will be offered an HIV test. A blood test You have been referred to this department will be drawn together with your routine du to suspected or confirmed infection with blood tests. You can ask any questions you Tuberculosis (TB). TB is a contagious may have. Declining to have an HIV test will infection that usually affects the lungs, but in no way affect the care you receive. it can also affect other parts of the body, You will be asked to sign a written consent like the spine or the brain. It is caused by to have the HIV test done. bacteria and is transmitted via saliva – Anyone who accepts an HIV test will receive coughing and sharing household with a TB the test result. The result is confidential and infected person. You can have the bacteria known only to you and your treating in your body, but your immune system /nurse. Taking the test, and testing negative, has no stops them from spreading and you will implications for insurance or mortgage neither be sick nor contagious. If your applications. immune system is suddenly impaired, the If the result is positive, you will be referred bacteria will start spreading and you will to the infectious diseases ward, where you get sick. One reason for an impaired will receive treatment and care for HIV. immune system could be an HIV infection. Thank you for taking the time to read this It is important to emphasize that most information. people with TB will NOT have HIV infection.

But we think it is worthwhile that everyone takes the test. Please keep this leaflet for your reference.

A routine HIV test of all patients will help us to identify the patients with HIV and provide timely treatment and care

HIV (the Human Immunodeficiency Virus) is now a manageable condition with medication. Treatment is very successful, but it is most successful if the infection is identified at an early stage. The majority of patients will be on straightforward treatment experiencing few, if any, side effects.

Partial Results Consortium Croatia Hrvatski zavod za javno zdravstvo Republican Centre for Addictive Croatian Institute of Public Health Disorders Life Quality Improvement Organisation "FLIGHT" Centre for Communicable Diseases and AIDS Croatian association for HIV and viral hepatitis Vilnius University Hospital Santaros Klinikos ISKORAK Malta Denmark Health Promotion and Disease Prevention Region Hovedstaden / CHIP National AIDS Centre Estonia Agency of the Ministry of Health Tervise Arengu Instituut National Institute for Health Romania Development “Victor Babes” Clinical Hospital of Infectious Diseases and Pneumophtisiology Craiova Greece Centre for Research & Technology Hellas, Institute of Applied Biosciences, Information “Marius Nasta” Technologies institute Pneumophtisiology Institute

Hellenic Center for Disease Serbia Control & Prevention Institute of Public Health of Serbia “Dr Milan Jovanovic Batut” Semmelweis University Slovakia Slovak Medical University in Bratislava Ireland University College Dublin, Slovenia National University of Dublin, Ireland National Institute of Public Health Nacionalni inštitut za javno zdravje Arcigay Associazione LGBTI Italiana Spain Centre d'Estudis Epidemiològics sobre Croce Rossa Italiana les ITS i Sida de Catalunya Consorci Institut d’Investigacions Biomèdicas Fondazione LILA Milano ONLUS - August Pi i Sunyer Lega Italiana per la Lotta contro l'AIDS Instituto de salud pública y laboral de Navarra Fondazione Villa Maraini Onlus

Lithuania United Kingdom National Public Health Public Health England Surveillance Laboratory